Preoperative Glucocorticoid Use in Major Abdominal Surgery Systematic Review and Meta-Analysis of Randomized Trials

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dc.contributor.author Srinivasa, Sanket en
dc.contributor.author Kahokehr, AA en
dc.contributor.author Yu, Tzu-Chieh en
dc.contributor.author Hill, Andrew en
dc.coverage.spatial United States en
dc.date.accessioned 2012-03-21T00:21:29Z en
dc.date.issued 2011-08-01 en
dc.identifier.citation Annals of Surgery 254(2):183-191 01 Aug 2011 en
dc.identifier.issn 0003-4932 en
dc.identifier.uri http://hdl.handle.net/2292/14840 en
dc.description.abstract Objective: To determine the clinical safety and efficacy of preoperative glucocorticoid (GC) administration in major abdominal surgery with regards to short term outcomes. Background: Previous randomized controlled trials (RCTs) in major abdominal surgery have displayed conflicting results regarding the short-term benefits of preoperative GC administration. Importantly, the safety of this intervention has not been conclusively determined. Methods: A systematic review and quantitative meta-analysis was conducted of all RCTs exploring preoperative GC administration in major abdominal surgery for the endpoints of complications, hospital length of stay (LOS) and serum IL-6 on postoperative day one. Subset analyses by procedure were planned “a priori.” Results: Eleven RCTs of moderate quality, comprising 439 patients in total, were included in the final analysis. Preoperative GC use decreased complications (OR = 0.37; 95% CI, 0.21–0.64; P < 0.01), LOS (mean = 1.97 days; 95% CI, -3.33 to -0.61; P = 0.01), and serum IL-6 (mean: -55 pg/mL; 95% CI, -82.30 to -27.91; P < 0.01). Preoperative GCs decreased complications in hepatic resection (OR = 0.28; 95% CI, 0.14–0.55; P < 0.01) and mean LOS (mean LOS: -2.66; 95% CI, -5.01 to -0.32; P = 0.03). GCs reduced mean LOS in patients undergoing colorectal surgery (mean LOS: -0.98; 95% CI, -1.67 to -0.27; P = 0.01). There was no difference in complication rates (OR: 0.45; 95% CI, 0.16–1.32; P = 0.15) or anastomotic leaks specifically. Conclusions: Preoperative administration of GCs decreases complications and LOS after major abdominal surgery as a likely consequence of attenuating the postsurgical inflammatory response. There is no evidence of increased complications in colorectal surgery. en
dc.language English en
dc.publisher Lippincott, Williams & Wilkins en
dc.relation.ispartofseries Annals of Surgery en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.subject Science & Technology en
dc.subject Life Sciences & Biomedicine en
dc.subject Surgery en
dc.subject HIGH-DOSE METHYLPREDNISOLONE en
dc.subject CARDIAC-SURGERY en
dc.subject METABOLIC-RESPONSE en
dc.subject HEPATIC RESECTION en
dc.subject PERITONEAL INFLAMMATION en
dc.subject SURGICAL COMPLICATIONS en
dc.subject POSTOPERATIVE RECOVERY en
dc.subject LIVER-TRANSPLANTATION en
dc.subject ADRENAL INSUFFICIENCY en
dc.subject COLORECTAL SURGERY en
dc.title Preoperative Glucocorticoid Use in Major Abdominal Surgery Systematic Review and Meta-Analysis of Randomized Trials en
dc.type Journal Article en
dc.identifier.doi 10.1097/SLA.0b013e3182261118 en
pubs.issue 2 en
pubs.begin-page 183 en
pubs.volume 254 en
dc.rights.holder Copyright: Lippincott, Williams & Wilkins en
dc.identifier.pmid 21694581 en
pubs.author-url http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000292908700001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=6e41486220adb198d0efde5a3b153e7d en
pubs.end-page 191 en
dc.rights.accessrights http://purl.org/eprint/accessRights/RestrictedAccess en
pubs.subtype Article en
pubs.elements-id 217368 en
pubs.org-id Medical and Health Sciences en
pubs.org-id School of Medicine en
pubs.org-id South Auckland clinical school en
dc.identifier.eissn 1528-1140 en
pubs.record-created-at-source-date 2012-08-22 en
pubs.dimensions-id 21694581 en


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